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PubMed1996

Myofibrillar calcium sensitivity of isometric tension is increased in human dilated cardiomyopathies: role of altered beta-adrenergically mediated protein phosphorylation.

To examine the role of alterations in myofibrillar function in human dilated cardiomyopathies, we determined isometric tension-calcium relations in permeabilized myocytesized myofibrillar preparations (n = 16) obtained from left ventricular biopsies from nine patients with dilated cardiomyopathy (DCM) during cardiac transplantation or left ventricular assist device implantation. Similar preparations (n = 10) were obtained from six normal hearts used for cardiac transplantation. Passive and maximal Ca2+-activated tensions were similar for the two groups. However, the calcium sensitivity of isometric tension was increased in DCM compared to nonfailing preparations ([Ca2+]50=2.46+/-0.49 microM vs 3.24+/-0.51 microM, P < 0.001). In vitro treatment with the catalytic subunit of protein kinase A (PKA) decreased calcium sensitivity of tension to a greater degree in failing than in normal preparations. Further, isometric tension-calcium relations in failing and normal myofibrillar preparations were similar after PKA treatment. These findings suggest that the increased calcium sensitivity of isometric tension in DCM may be due at least in part to a reduction of the beta-adrenergically mediated (PKA-dependent) phosphorylation of myofibrillar regulatory proteins such as troponin I and/or C-protein.

Adolescent↗

PubMed1989

Doppler assessment of the effects of isometric stress on left ventricular filling in hypertensive young adults.

Doppler interrogation at the in-flow of the left ventricle was used to test the effects of isometric stress on ventricular filling in 7 hypertensive subjects with mild to moderate left ventricular hypertrophy, aged forty-two +/- seven years, compared with 9 matched healthy control males. In the hypertensive patients at rest, peak early diastolic (E) velocity was lower, and atrial (A) velocity higher, with lower E/A peak velocity ratios than in normals (p less than 0.05). These differences were more accentuated during isometric stress. Atrial filling fractions were higher in hypertensives (37 +/- 6%) than in normals (24 +/- 7%) at rest, p less than 0.05, and this difference increased during isometric stress (44 +/- 9% versus 30 +/- 11%). Thus, isometric stress accentuated the reliance of left ventricular filling on atrial contribution and may be applied for the detection of early ventricular filling abnormalities in patients with mild hypertension. The systolic blood pressure and the hypertrophic process were both important determinants of left ventricular diastolic filling.

Adult↗

PubMed2005

Isometric force production parameters during normal and experimental low back pain conditions.

BACKGROUND: The control of force and its between-trial variability are often taken as critical determinants of motor performance. Subjects performed isometric trunk flexion and extension forces without and with experiment pain to examine if pain yields changes in the control of trunk forces. The objective of this study is to determine if experimental low back pain modifies trunk isometric force production. METHODS: Ten control subjects participated in this study. They were required to exert 50 and 75% of their isometric maximal trunk flexion and extension torque. In a learning phase preceding the non painful and painful trials, visual and verbal feedbacks were provided. Then, subjects were asked to perform 10 trials without any feedback. Time to peak torque, time to peak torque variability, peak torque variability as well as constant and absolute error in peak torque were calculated. Time to peak and peak dF/dt were computed to determine if the first peak of dF/dt could predict the peak torque achieved. RESULTS: Absolute and constant errors were higher in the presence of a painful electrical stimulation. Furthermore, peak torque variability for the higher level of force was increased with in the presence of experimental pain. The linear regressions between peak dF/dt, time to peak dF/dt and peak torque were similar for both conditions. Experimental low back pain yielded increased absolute and constant errors as well as a greater peak torque variability for the higher levels of force. The control strategy, however, remained the same between the non painful and painful condition. Cutaneous pain affects some isometric force production parameters but modifications of motor control strategies are not implemented spontaneously. CONCLUSIONS: It is hypothesized that adaptation of motor strategies to low back pain is implemented gradually over time. This would enable LBP patients to perform their daily tasks with presumably less pain and more accuracy.

Adult↗

PubMed2003

Five years of growth hormone replacement therapy in adults: age- and gender-related changes in isometric and isokinetic muscle strength.

GH replacement therapy in adults with adult-onset GH deficiency (GHD) has been shown to increase isometric and isokinetic muscle strength in a few trials with limited numbers of patients. In this single center, prospective, open-label study, the effects of 5-yr GH replacement therapy on muscle function were determined in 109 consecutive adults (61 men and 48 women) with adult-onset GHD. The mean initial GH dose was 0.88 mg/d. The dose was gradually lowered, and after 5 yr the mean dose was 0.46 mg/d. The mean IGF-I SD score increased from -1.54 at baseline to 1.53 at study end. A sustained increase in lean body mass and decrease in body fat was observed. The GH treatment induced persistent increases in isometric knee flexor strength, concentric knee flexor strength at an angular velocity of 60 degrees/sec, and right-hand peak grip strength. After correction for age and gender using observed/predicted value ratios, a sustained increase was also observed in isometric (60 degrees) and concentric (180 degrees/sec) knee extensor strength, average right-hand grip strength for 10 sec, and left-hand grip strength. At study end, knee flexor and extensor strength was 96-104% of predicted and hand grip strength was 84-90% of predicted values. The local muscle endurance was transiently decreased after correction for age and gender. No gender difference was found in the treatment responses in muscle strength. However, muscle strength (also after correction for age and gender) was lower in women than men throughout the study period. In conclusion, GH replacement therapy in adults with adult-onset GHD normalized isometric and isokinetic knee flexor and extensor strength. Hand grip strength increased but was not fully normalized.

Adipose Tissue↗

PubMed1977

Effect of isometric handgrip exercise on left ventricular function in the patient with artificial cardiac pacemaker.

The cardiovascular effects of isometric handgrip exercise were determined with a nonivasive method in the patient with artificial pacemaker. The arterial blood pressure was measured with mercury manometer as well as cardiac output by the dye dilution method with Indocyanin green before and after handgrip exercise. Isometric handgrip exercise produced a significant increase in the left ventricular ejection time, the left ventricular ejection time/the preejection period, the ejection time index/the isometric contraction time, the arterial blood pressure and cardiac output and a significant decrease in the preejection time and the isometric contraction time. Cardiac output was increased more remarkably in the negative Master two step test group than in the positive Master two step test group. There was found a significant positive relationship between the increase in cardiac output and P wave rate upon handgrip exercise.

Adolescent↗

PubMed1990

Effects of the calmodulin antagonist W-7 on isometric tension development and myosin light chain phosphorylation in bovine tracheal smooth muscle.

Effects of N-(6-aminohexyl)-5-chloro-1-naphthalenesulfonamide (W-7) on isometric tension development and myosin light chain (P-LC) phosphorylation were determined in intact smooth muscle strips of bovine trachea. Addition of 10(-5) M carbachol resulted in a marked increase in the P-LC phosphorylation within 30 sec of stimulation. Subsequently, there was a gradual decrease in the P-LC phosphorylation. In contrast, steady-state contraction was not attained until 10 min of stimulation. In these strips, W-7 itself caused a contraction, probably due to the release of endogenous histamine that was blocked by pyrilamine. In the presence of W-7 and pyrilamine, the isometric tension development and P-LC phosphorylation during the initial 5-min stimulation period were inhibited. Concentrations of W-7 that caused a 50% inhibition were 145 and 125 microM, respectively, for tension and phosphorylation. N-(6-aminohexyl)-1-naphthalenesulfonamide (W-5), a weak calmodulin antagonist, produced no significant inhibition on the carbachol-induced isometric tension development and P-LC phosphorylation. After 10-min exposure to carbachol, W-7 inhibited the steady-state contraction without inhibition of the P-LC phosphorylation. These results suggest that 1) W-7 inhibits the smooth muscle contraction through the inhibition of the initial increase in the P-LC phosphorylation and 2) the maintenance of isometric tension (after 10 min exposure to carbachol) in unlikely to depend on the P-LC phosphorylation.

Animals↗

PubMed2005

Influence of age on isometric, isotonic, and isokinetic force production characteristics in men.

BACKGROUND AND PURPOSE: Most previous studies have focused on the effects of age on muscle performance of a single type of contraction, usually isometric, and usually on only a single muscle group. Instead,we investigated the influence of age on isometric, isotonic, and isokinetic muscle performance in men aged 20-83 years and determined relationships between regional lean body mass and muscle performance. METHODS: Seventy-five volunteers were placed into designated 10-year age groups: 20-29 (n=13), 30-39 (n=14), 40-49 (n=15), 50-59 (n=10), 60-69 (n=14), and 70+ years (n=9). Muscle performance was characterized by a number of parameters, including strength, time, and rate for maximal voluntary contractions using all 3 contraction types and 4 muscle groups (elbow extensors, elbow flexors, knee extensors, and knee flexors). Measures of lean body mass were obtained by dual energy x-ray absorptiometry. RESULTS: There were significant age group differences in maximal force (P < or = 0.05) for each type of muscle contraction, and in maximal rates of isometric force production (P < or = 0.05), with declines beginning around 60 years of age. Differences in muscle performance between age groups remained when body composition differences were controlled statistically. CONCLUSION: Chronological age affected performance of both upper and lower extremity muscles, independent of muscle mass, and regardless of contraction type; however, isometric performance was the least affected.

Adult↗

PubMed2003

Changes in dynamic exercise performance following a sequence of preconditioning isometric muscle actions.

Complex training is the method of coupling heavy and light loads into an organized sequence with the aim of facilitating postactivation potentiation. Anecdotal evidence has supported the use of complex training sequences, but scientific studies investigating the effects of sequencing isometric loads with dynamic muscle actions have been limited. The purpose of this study was to examine the effects of a preconditioning sequence of maximal isometric knee extensions on performance standards in selected dynamic whole-body exercise. Fourteen track and field athletes (23 +/- 5.7 years; 71.53 +/- 6.93 kg; 172.6 +/- 5.8 cm) were randomly assessed in selected whole-body exercises (drop and countermovement jumps, 5-second cycle sprint, knee extension) following a sequence of maximal voluntary isometric contractions (MVC; 3 repetitions of 3 seconds or 3 repetitions of 5 seconds) or in the absence of prior loading (control). Electromyographic (EMG) assessments of muscle activity were also made during the knee extension assessment. Significant (p < or = 0.05) increases in jump height (5.03%), maximal force (4.94%), and acceleration impulse (9.49%) were observed in the drop jump following 3 repetitions of 3-second MVC only. Knee extension maximal torque was also significantly increased (6.12%) following the 3-second MVC. No significant changes in countermovement jump or cycle sprint measures were observed for any of the experimental conditions. Though adaptations were found, changes in EMG activity were not significantly different for any of the experimental conditions. These data indicate that performing a sequence of repeated maximal isometric knee extensions (3 repetitions of 3 seconds) prior to selected dynamic exercise (< or =0.25 seconds) may have favorable effects on performance beyond standards achieved without prior heavy loading.

Adult↗

PubMed1983

Thigh and calf blood flows after isometric contraction in untrained and trained subjects.

The present study was undertaken to examine whether or not there were any differences between untrained and trained subjects in the changes of blood flow in the ipsilateral and contralateral lower limbs after isometric exercise. Blood flow of the thigh and calf in both right and left legs were measured simultaneously before and after isometric contraction with mercury-in-silastic strain gauge venous occlusion plethysmography. In the present study, the main pattern of blood flow responses in the active and non-active limbs was strikingly similar in all subjects: a significant fall in blood flow immediately after isometric contraction at a force of about 50% of maximal muscle strength for 15 sec was observed in the non-active lower limbs. Peak blood flow of the exercised thigh in the trained group was significantly higher than that in the untrained ones. From these results, it was suggested that higher blood flow after isometric exercise in the trained subjects may be due to the improvement of degree of vasodilation in the lower limb as a result of physical training.

Adult↗

PubMed2000

Logistic time constant of isometric relaxation force curve of ferret ventricular papillary muscle: reliable index of lusitropism.

We have found that a logistic function fits the left ventricular isovolumic relaxation pressure curve in the canine excised, cross-circulated heart more precisely than a monoexponential function. On this basis, we have proposed a logistic time constant (tau(L)) as a better index of ventricular isovolumic lusitropism than the conventional monoexponential time constant (tau(E)). We hypothesize in the present study that this tau(L) would also be a better index of myocardial isometric lusitropism than the conventional tau(E). We tested this hypothesis by analyzing the isometric relaxation force curve of 114 twitches of eight ferret isolated right ventricular papillary muscles. The muscle length was changed between 82 and 100% L(max) and extracellular Ca(2+) concentrations ([Ca(2+)](o)) between 0.2 and 8 mmol/l. We found that the logistic function always fitted the isometric relaxation force curve much more precisely than the monoexponential function at any muscle length and [Ca(2+)](o) level. We also found that tau(L) was independent of the choice of the end of isometric relaxation but tau(E) was considerably dependent on it as in ventricular relaxation. These results validated our present hypothesis. We conclude that tau(L) is a more reliable, though still empirical, index of lusitropism than conventional tau(E) in the myocardium as in the ventricle.

Animals↗

PubMed1998

Identifying submaximal muscular effort: reliability of difference scores calculated from isometric and isokinetic measurements.

The present investigation examined the reliability of a derived strength measurement and also how variability between test sessions affects the utility of this variable for judging an individual's muscular effort. 31 young healthy men (M age = 25 yr.) completed three isometric and isokinetic concentric contractions of the knee extensors, using maximal and self-selected submaximal efforts, on each of two test sessions. Difference scores between isometric and isokinetic measurements were calculated by subtracting the mean of the three isokinetic peak torques from the mean of the three isometric peak torques for each individual subject for maximal and submaximal efforts performed on both test sessions. For the group of subjects, difference scores were significantly greater during maximal (33 +/- 29 Nm) than submaximal (13 +/- 30 Nm) efforts, suggesting subjects could not maintain the same relationship between isometric and isokinetic muscular actions across the maximal and submaximal conditions. However, the test-retest reliability of the difference scores was only modest even when data were averaged over two test sessions (intraclass correlation coefficients were .82 for maximal, and .58 for submaximal). As a result, the range of scores within which an individual's true score might be expected to lie was large (+/- 25 Nm for maximal, and +/- 37 Nm for submaximal). Although derived strength parameters like difference scores may be effective in distinguishing submaximal from maximal efforts completed by groups of subjects, the test-retest reliability of the present scores suggests that their use in judging an individual's performance may be limited.

Adult↗

PubMed2001

Influence of joint position on electromyographic and torque generation during maximal voluntary isometric contractions of the hamstrings and gluteus maximus muscles.

STUDY DESIGN: Repeated measures analysis of joint angle effects on hip and knee muscle electromyographic (EMG) activity. OBJECTIVES: To simultaneously determine angle-dependent changes in maximal voluntary isometric contraction (MVIC) torque and EMG activity during hip extension and knee flexion. BACKGROUND: Procedures for normalizing EMG data and for determining torque-angle relationships for various joint motions both entail asking subjects to exert an MVIC. The implicit assumption in these paradigms is that magnitude of the EMG response is at a constant, maximum level so that observed angle-dependent variations in torque are due to mechanical factors, such as muscle length and muscle moment arm. METHODS AND MEASURES: Fifty subjects (25 men and 25 women) participated in this study (age, 23.5 +/- 4.6 y; range, 18-38 y). Subjects performed maximal isometric knee flexion at 4 knee angles and maximal isometric hip extension at 4 hip angles. The dependent variables were normalized root-mean-square EMG and torque. The process for normalizing EMG and torque data consisted of determining the largest mean value for each subject across testing positions for the muscle of interest. That value was designated as corresponding to 100% MVIC, and all other data for that muscle were expressed as a percentage of the MVIC value. Repeated measures was used to determine angle-dependent changes in normalized MVIC-torque and MVIC-EMG values for each muscle group. RESULTS: Mean torque-angle relationships were generally consistent with previous reports, though considerable intersubject variability was observed. There were significant angle-dependent differences in maximal EMG for both the hamstring and gluteus maximus muscles. Mean percentages of hamstring MVIC-EMG at knee angles of 30 degrees (81 +/- 19) and 60 degrees (82 +/- 22) were greater than at 0 degrees (68 +/- 20) or 90 degrees (74 +/- 20). The mean percentage of gluteus maximus MVIC-EMG at a hip angle of 0 degrees (94 +/- 10) was greater than at 30 degrees (84 +/- 13), 60 degrees (80 +/- 14), or 90 degrees (64 +/- 20), and gluteus maximus maximal voluntary isometric EMG at 90 degrees was less than at all other angles. These differences could not be explained solely by muscle length-dependent effects on EMG amplitude, suggesting that despite instructions for maximal effort, motor unit activation was not maintained at a constant, maximal level throughout the range of motion. The form of the EMG/angle relationships differed markedly from the torque-angle relationships. CONCLUSIONS: These findings have implications for the use of MVIC-EMG for reference values in EMG normalization procedures and for the interpretation of mechanisms underlying the torque-angle relationships observed in vivo.

Adult↗

PubMedDate not supplied

Isometric handgrip exercise-induced muscarinic vasodilation in the human skin microvasculature.

The existence of an active vasodilator system in the human skin microvasculature is well documented, but its physiological role and the underlying mechanisms are not completely understood. Cutaneous blood flow increases during isometric handgrip exercise. To examine whether this response is mediated by active vasodilation, isometric handgrip exercise testing was performed in nine healthy subjects. Local iontophoresis of atropine was applied to the forearm skin. Skin blood flow (SBF) monitoring by means of laser Doppler flowmetry was combined with continuous noninvasive blood pressure monitoring. SBF monitoring was performed at a site pretreated with atropine and an adjacent control area. Mean arterial pressure (MAP) was recorded noninvasively. Cutaneous vascular resistance (CVR) was calculated as MAP/SBF for the atropine treated and the control areas. Changes in CVR were expressed as percent deviation from the baseline (dCVR). Isometric handgrip exercise resulted in a marked reduction in CVR at the control site (dCVR: -66 +/- 4%). In contrast, the CVR was not significantly altered at the atropinetreated site (2.4 +/- 7%). It is concluded that isometric exercise induces an atropine-sensitive vasodilation which is mediated by muscarinic receptors in the human skin.

Adult↗

PubMed1999

Hemoglobin near-infrared spectroscopy and surface EMG study in muscle ischaemia and fatiguing isometric contraction.

BACKGROUND: To assess how muscle ischaemia and isometric fatiguing contraction influence oxygen content in striated muscle. METHODS: We simultaneously measured changes in hemoglobin near-infrared (NIR) spectroscopy and in surface EMG before, during, and after muscle ischaemia and ischaemia plus muscle isometric fatiguing contraction. Seventeen healthy male subjects (age range: 19-40 yrs) were examined in our Clinical Neurophysiology Unit. Test I (9 subjects): hemoglobin NIR spectroscopy and stimulated surface EMG were measured for 2 minutes at rest, for 4 minutes during complete ischaemia of tibialis anterior muscle, and for twelve minutes during recovery. Test II (all subjects): hemoglobin NIR spectroscopy and surface EMG were measured for 2 minutes with the subjects performing brief non-fatiguing contractions, for 4 minutes with the subject performing maximal isometric contraction in complete ischaemia, and for twelve minutes during recovery. EMG parameters measured: median density frequency (MDF); muscle fiber conduction velocity (MFCV). NIR spectroscopy parameters measured: percentage of amplitude decrement (% AD) and nadir time (NT) during ischaemia and ischaemic effort; half-recovery time (1/2 RT) from ischaemia effort. RESULTS: At EMG, we observed a significant shift towards lower values of both MFCV and MDF during fatiguing isometric contraction. MDF recovery was faster then MFCV recovery. At NIR spectroscopy, the 1/2 RT slowed a fast pattern in twelve subjects and a slow pattern in five. A significant relationship was found between AD% and 1/2 RT values of test I and AD% and 1/2 values of test II. We found a positive relationship between NT and 1/2 RT in test II. CONCLUSIONS: Surface EMG and hemoglobin NIR spectroscopy can be applied simultaneously to evaluate both fatigue intensity and blood flow changes in striated muscle.

Adult↗

PubMed1975

Isometric rowing strength of experienced and inexperienced oarsmen.

The significance of isometric muscle strength for rowing performance was studied. The questions investigated were: A) Is the isometric rowing strength (IRS) of oarsmen which is two to three times the dynamic force applied on the oar at maximal power rowing, a ratio which is equivalent to the maximal efficiency of Hill's force/velocity relationship? B) Is IRS higher among successful oarsmen that among those less so? C) Is isometric strength of individual muscle groups correlated to IRS? From measurments on 40 oarsmen the results showed: a) IRS among the most successful oarsmen was 2.6 times the dynamic force indicated in literature; b) IRS was 21 kp higher in the 7 international competitive oarsmen than in 22 national oarsmen, and 42 kp higher than IRS of 11 club oarsmen; and c) of eight other strength determinations only hand grip strength was correlated to IRS. It is suggested that IRS, but not isometric strength of individual muscle groups limits rowing performance.

Adult↗

PubMed2004

Mechanomyographic time and frequency domain responses of the vastus medialis muscle during submaximal to maximal isometric and isokinetic muscle actions.

The purpose of this study was to examine the patterns for the mechanomyographic (MMG) amplitude and mean power frequency (MPF) versus torque relationships during isometric and isokinetic muscle actions. Ten adults (mean age +/- SD = 22 +/- 1 y) volunteered to perform isometric and isokinetic leg extension muscle actions at 10, 20, 30, 40, 50, 60, 70, 80, 90, and 100% of peak torque on a Cybex II dynamometer. A piezoelectric crystal contact sensor was placed on the vastus medialis to detect the MMG signal. Regression analyses indicated that for the isometric muscle actions, the relationships for MMG amplitude (R2 = 0.998) and MPF (R2 = 0.987) versus torque were cubic. For the isokinetic muscle actions, the relationships for MMG amplitude (r2 = 0.927) and MPF (r2 = 0.769) versus torque were linear. The different patterns for MMG amplitude and frequency may reflect differences in the motor control strategies that modulate torque production for isometric versus dynamic muscle actions.

Adult↗

PubMed2004

The role of genetics and environment in lifting force and isometric trunk extensor endurance.

BACKGROUND AND PURPOSE: Our understanding of what different back performance tests are measuring is limited. The purpose of this study was to investigate the relative contributions of genetics and unique and common environmental factors for 3 tests of back muscle performance in a classic twin analysis. SUBJECTS: The subjects were a population-based sample of 122 monozygotic and 131 dizygotic male twin pairs aged 35 to 69 years (mean=49.9, SD=7.7). METHODS: Variance component analysis was applied to estimate genetic and environmental influences on isokinetic and psychophysical lifting and isometric trunk extensor endurance test performance. The Cholesky decomposition genetic factor model was used to estimate genetic and environmental correlations of these variables. Path analysis was applied to study determinants of isokinetic and psychophysical lifting and isometric trunk extensor endurance test performance. RESULTS: Genetic effects accounted for 60%, 33%, and 5% of the total variance of isokinetic and psychophysical lifting forces and isometric trunk extensor endurance, respectively, and unique environmental factors accounted for 35%, 49%, and 61% of the variance. DISCUSSION AND CONCLUSION: Genetics had a dominant role in isokinetic lifting and unique environmental factors in isometric trunk extensor endurance. The relatively high role of genetics in lifting force suggests the potential to increase and sustain changes in back muscle force in the general population may be particularly challenging.

Adult↗

PubMedDate not supplied

Complementary roles of central command and muscular reflex in the regulation of heart rate during submaximal isometric contraction.

During submaximal isometric contraction, the heart rate (HR) and the electromyographic activity (EMG) increase continuously. Although activation of the muscle and the cardiovascular center is placed partly under the common control of the central command, the nature of the relationship that may exist between HR and the integrated electromyogram (iEMG) is seldom studied. Seventeen healthy men, 22.4 +/- 0.5 years of age (M +/- SE), performed isometric contractions with the right elbow flexors. Forces of 25, 40, 50 and 65% of the maximum voluntary contraction (MVC) were used, and the contractions were sustained until (isotonic isometric contraction: IIC) and beyond exhaustion (anisotonic isometric contraction: AIC). During IIC, a linear relationship exists between HR and iEMG; the slope of this relationship is independent of the relative force developed, which is in favor of a predominant role played by the central command in HR increase. The increase in the ratio iEMG/HR at the approach of local muscular exhaustion would indicate that at the end of IIC there is an increase in the relative part furnished by the information of peripheral origin in HR regulation. During AIC, the force (F) decreases in an exponential manner and stabilizes at around 25% MVC from tAIC = 70 s on. The iEMG and HR change independently: iEMG decreases like F such that iEMG/F remains constant; HR continues to increase in the first phase corresponding to the rapid decrease in F and iEMG, then in a second phase, it decreases linearly with respect to time. Our results suggest that the action of the central command is dominant during stage 1 of AIC, while during stage 2 the relative part furnished by the muscle reflexes increases. Beyond tAIC = 70 s, there seems to be a certain degree of central fatigue.

Adolescent↗